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Current and Emerging Pharmacotherapy for Fibromyalgia
Open accessAbstract
Introduction . Fibromyalgia syndrome (FMS) is a pain disorder with an estimated prevalence of 1–5%. It is associated with a variety of somatic and psychological disorders. Its exact pathogenesis is still unclear but is involved with neural oversensitization and decreased conditioned pain modulation (CPM), combined with cognitive dysfunction, memory impairment, and altered information processing. Connectivity between brain areas involved in pain processing, alertness, and cognition is increased in the syndrome, making its pharmacologic therapy complex. Only three drugs, pregabalin, duloxetine, and milnacipran are currently FDA-approved for FM treatment, but many other agents have been tested over the years, with varying efficacy. Areas Covered . The purpose of this review is to summarize current clinical experience with different pharmacologic treatments used for fibromyalgia and introduce future perspectives in developing therapies. Expert Opinion . Future insights into the fields of cannabinoid and opioid research, as well as an integrative approach towards the incorporation of genetics and functional imaging combined with additional fields of research relevant towards the study of complex CNS disorders, are likely to lead to new developments of novel tailor-made treatments for FMS patients.
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“Fourth, it is compliant with the generally poor efficacies of drugs currently used in FM therapy, but also with the relatively higher efficacy of gabapentinoids [7,140].”
From Fibromyalgia pathogenesis explained by a neuroendocrine multistable model (2024) · cites this paper as [140]
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“For what concerns FM, both pharmacological and nonpharmacological therapies are generally disappointing, providing very limited benefit to FM patients [4,140,155,156].”
From Fibromyalgia pathogenesis explained by a neuroendocrine multistable model (2024) · cites this paper as [140]
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“اکنون شواهدی وجود دارد که برای درمان فیبرومیالژیا از چندین گزینه دارویی مثل داروهای ضدافسردگی و ضدتشنج و درمان غیردارویی مثل درمان شناختی رفتاری استفاده میشود ] 8 [ .”
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“Gabapentinoid medications are commonly prescribed for the treatment of FM (Cooper et al., 2017; Tzadok and Ablin, 2020).”
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“However, reduced conditioned pain modulation and neural over-sensitization are suggested mechanisms [2].”
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Kinin B1 receptor is involved in mechanical nociception in a fibromyalgia-like model in mice
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“Additionally, fibromyalgia treatment is complex, and the current pharmacological options available display limited effects and often have adverse side effects (7,8) .”
BackgroundPain Management in Fibromyalgia: Evaluating the Roles of Pregabalin, Duloxetine, and Milnacipran
Ejaz, K. F., Wani, R., Akbar, A., Khan, Q. U., Ishtiaq, H., Amir, M., Ali, A. I., & Khan, S. U. (2024) · Cureus · doi:10.7759/cureus.76631 · Cited by 3
Fibromyalgia from a psychiatric point of view
Hasterok, M., Piegza, M. J., & Dębski, P. G. (2021) · Psychiatria i Psychologia Kliniczna · doi:10.15557/pipk.2021.0014 · Cited by 3
Barrot, M., Basile, H.-P., & Kremer, M. (2025) · Advances in neurobiology · doi:10.1007/978-3-031-96364-3_12 · Cited by 3
The 4th International Virtual Congress on Controversies in Fibromyalgia
Ablin, J. N., & Sarzi‐Puttini, P. (2022) · Clinical and Experimental Rheumatology · doi:10.55563/clinexprheumatol/ajiygc · Cited by 2
“The complexity of the fatigue experience in patients with RA, encompassing physical, cognitive, daily living and emotional impacts, can be difficult to be managed (11, 12).”
BackgroundPrevalência da dor e percepção do tratamento em pacientes com fibromialgia
de Araújo, L. V. F., Caires, P. T. P. R. C., Pinheiro, T. G., Gusmão, L. C., Santos, L. A., Souza, D. C., de Lima, C. R. C., Correia, F. S. A., de Oliveira, D. A., & Lessa, R. S. (2022) · Revista Eletrônica Acervo Saúde · doi:10.25248/reas.e10856.2022 · Cited by 2
Uma abordagem geral da Fibromialgia: revisão de literatura
de Athayde, I. B., Marques, E. T. D. F., & Côrtes, J. P. D. R. (2022) · Revista Eletrônica Acervo Médico · doi:10.25248/reamed.e10934.2022 · Cited by 2
Identification of the Involvement of Potassium Channels in Fibromyalgia
Lawson, K. (2022) · Frontiers in Bioscience-Scholar · doi:10.31083/j.fbs1404029 · Cited by 2
“The benefits reported have been dose-related pain alleviation with improvement in quality of life and sleep [40].”
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Zhang, C. Y., Zhang, P., Zhao, Y., Liu, Y., Yun, H., Zhu, Z., & Xiao, H. (2025) · Journal of Medical Internet Research · doi:10.2196/71624 · Cited by 2
“…with fibromyalgia who have been taking medication for a long time have adverse reactions such as dizziness, drowsiness, nausea, and vomiting, and some even stop taking the drug on their own because they cannot tolerate the adverse reactions [6,7], which results in the continued use of medication.”
Häuser, W. (2020) · Aktuelle Rheumatologie · doi:10.1055/a-1182-5630 · Cited by 2
“Die Liste der Medikamente, welche in RCTs keine Überlegenheit gegenüber Placebo zeigten bzw. in keinen weiteren Studien getestet wurden, ist lang [ 48 ].”
Duloxetine: an effective treatment for fibromyalgia syndrome?
Elahi, N., & Ellahi, A. (2023) · International Journal of Surgery Global Health · doi:10.1097/gh9.0000000000000093 · Cited by 2
Tobajas, Y., Alemany-Fornés, M., Samarra, I., Romero‐Giménez, J., Castellana, J. C., Tintoré, M., del Pino, A., Canela-Canela, N., Bas-Prior, J. M. D., Ortega-Olivé, N., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13030792 · Cited by 2
“Fibromyalgia management often involves medications related to mental health or neurological conditions (antidepressants or anticonvulsants are also prescribed to reduce pain and enhance mood) [31–33] and their classifications reflect their mechanisms of action and therapeutic purposes.”
BackgroundAkbarian, M., PhD Candidate, D. O. H. P., Saeidi, N., MSc, D. O. M. H., Borjali, A., Professor, D. O. C. P., Abolghasemi, S., Assistant Professor, D. O. I. M., Hassanabadi, H. R., & Associate Professor, D. O. E. P. (2022) · Avicenna Journal of Clinical Medicine · doi:10.52547/ajcm.28.4.244 · Cited by 1
Cohen-Biton, L., Buskila, D., & Gannot, R. N. (2024) · BioMed · doi:10.3390/biomed4020006 · Cited by 1
“FM is associated with neurosensitivity and reduced conditioned pain modulation (CPM) [9].”
BackgroundEffects of connective tissue massage and kinesiotaping in patients with fibromyalgia
Turksen, G., Kısa, E. P., Kaya, B. K., Muammer, K., & Muammer, R. (2024) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2024.07.009 · Cited by 2
The medico-legal pertinence of musculoskeletal nociplastic pain
Fitzcharles, M., & Assis, R. D. (2025) · Medico-Legal Journal · doi:10.1177/00258172241285986 · Cited by 1
Shtoots, L., Halpert, G., Partouche, R., Levy, D. A., Amital, H., & Shoenfeld, Y. (2025) · Brain Research · doi:10.1016/j.brainres.2025.149980 · Cited by 1
Bertin, C., Dupouy, J., Authier, N., Michenot, N., Verdier, S., Chappuy, M., & Trouvin, A. (2026) · Pain and Therapy · doi:10.1007/s40122-026-00853-8 · Cited by 2
Santos, T. C. A., Gomes, I. A., & Menezes, P. D. P. (2022) · Research Society and Development · doi:10.33448/rsd-v11i9.31684 · Cited by 1
Intervenciones farmacológicas en fibromialgia; consideraciones actuales
Gálvez, L. A., & Vega, D. A. M. (2022) · Revista de la Sociedad Española del Dolor · doi:10.20986/resed.2022.4001/2022 · Cited by 1
Chronic Neuropathic Pain: Fibromyalgia
Miedany, Y. M. E. (2022) · Contemporary rheumatology · doi:10.1007/978-3-031-10687-3_11 · Cited by 1
Fibromialgia e disfunção temporomandibular: uma revisão de escopo
Bosco, T. D., Torres, I. L. D. S., Stein, D. J., & de Oliveira, F. F. (2023) · Clinical & Biomedical Research · doi:10.22491/2357-9730.128039 · Cited by 3
Das Fibromyalgiesyndrom als Schmerzsyndrom in der Rheumatologie
Krasselt, M., & Baerwald, C. (2023) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/a-1965-6870 · Cited by 1
“Frü-her durchgeführte Untersuchungen erbrachten zum Teil widersprüchliche Ergebnisse [24].”
BackgroundVilalta‐Abella, F., Porras-García, B., Ghiţă, A., Vacas, M., Prat, M., & Gutiérrez‐Maldonado, J. (2023) · British Journal of Pain · doi:10.1177/20494637231210391 · Cited by 1
Effect of Steroids on Patients With Fibromyalgia/Chromic Widespread Pain: An Observational Study
Gurunathan, O. S., Eswaradass, C., Thirunavukkarasu, S., Thermalingem, S., & Eswaradass, P. V. (2024) · Cureus · doi:10.7759/cureus.53736 · Cited by 1
Imamura, M., Robertson, C., Hudson, J., Whibley, D., Aucott, L. S., Gillies, K., Beasley, M., Stevens, M., Manson, P. D., Dulake, D., et al. (2025) · Health Technology Assessment · doi:10.3310/gtbr7561 · Cited by 2
Prevalence, Diagnostic Challenges and Management of Fibromyalgia
Baoum, S. O., AlShaikh, S., Albaqsh, N., AlAmry, S., AlHussain, M., Almehmadi, A., Al-Asmari, Y. A., Albeetar, W. M., Azi, N., Alkathiri, O., et al. (2023) · Journal of Healthcare Sciences · doi:10.52533/johs.2023.30108 · Cited by 1
Understanding Fibromyalgia 2020
Schreibman, C. (2020) · Physician Assistant Clinics · doi:10.1016/j.cpha.2020.09.002
Kalcev, G., Testa, G., Manconi, M., Bacchetta, G., Scano, A., Orrù, G., Deidda, M. C., Finco, G., & Carta, M. G. (2020) · Biointerface Research in Applied Chemistry · doi:10.33263/briac113.99289938
Alves, M. F., Silva, A. B. D. B., Ferreira, K. G., Cruz, B. G. R., Machado, L. C. D. S., de Souza, M. C. M. C., Júdice, M. G., & da Silva, R. C. D. (2020) · Journal Health NPEPS
Comborbid fibromyalgia with depression in geriatric
Natanael, R. J. M., Diniari, N. K. S., & Kuswardhani, R. A. T. (2022) · International journal of health & medical sciences · doi:10.21744/ijhms.v5n4.1996
Fibromyalgia in the light of different methods of treatment
Szota, M., Modlińska, A., Rogacka, K., & Kędziora–Kornatowska, K. (2022) · Journal of Education Health and Sport · doi:10.12775/jehs.2022.12.12.050
“Endokannabinoidy uwalniane są na skutek depolaryzacji komórek, a ich obecność prowadzi do pobudzenia receptora CB1, który hamuje presynaptyczne przekaźnictwo GABA-ergiczne i glutaminergiczne [13].”
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Pharmacologic Treatment Options in Functional Illness
Abijay, C. A., & Agan, A. D. (2023) · Springer eBooks · doi:10.1007/978-3-031-12998-8_20
Pain makes me anxious, and anxiety gives me pain
Jackson, D., & Pal, S. (2024) · Cambridge University Press eBooks · doi:10.1017/9781108623872.017
Metadata
- Authors
- Tzadok, R., & Ablin, J. N.
- Affiliations
- Tel Aviv University (IL)
- Corresponding author
- Tzadok, Roie
- Venue
- Pain Research and Management
- Publisher
- Wiley
- Published
- 2020-02-11
- Volume
- 2020
- Pages
- 1-9
- ISSN
- 1203-6765 (ISSN-L)
- 1918-1523
- PMC
- PMC7036118
- OpenAlex
- W3005953215
- Cited by
- 122
- References
- 86
- Citations by year
- 2026: 7 · 2025: 24 · 2024: 25 · 2023: 23 · 2022: 24 · 2021: 13 · 2020: 6
- FWCI
- 2.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Pain Research and Management (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- fibromyalgia, pharmacotherapy, pregabalin, duloxetine, milnacipran, conditioned pain modulation, cognitive impairment, pain processing, cannabinoid therapy, opioid therapy, personalized treatment, functional imaging
- MeSH terms
- Analgesics, Female, Fibromyalgia, Humans, Chronic Pain, Pain Management
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